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United States Patent |
5,291,902
|
Carman
|
March 8, 1994
|
Incontinence treatment
Abstract
A method of improving the pelvic floor muscle strength of a person in a
manner to lessen urinary incontinence includes placing surface electrodes
of electromyographic measuring apparatus on the perineum of the person,
measuring with said apparatus the bladder controlling pelvic floor muscle
strength of the person while the person is tensing the pelvic floor
muscles in a urine stopping manner to obtain an EMG signal, and adjusting
the threshold value of a portable electromyographic measuring unit to
enable the person to repeat the measurement at different times to attempt
to obtain better EMG signals in a urinary incontinence reducing sense. The
portable unit gives an audible and/or visual indication when an EMG signal
above the threshold value is achieved.
Inventors:
|
Carman; Brent (R.R. #1, Millarville, Alberta, T0L 1K0, CA)
|
Appl. No.:
|
003052 |
Filed:
|
January 11, 1993 |
Current U.S. Class: |
607/138 |
Intern'l Class: |
A61N 001/00 |
Field of Search: |
128/733,734,774,775,778,782,784,788
|
References Cited
U.S. Patent Documents
3236240 | Feb., 1966 | Bradley.
| |
3628538 | Dec., 1971 | Vincent et al.
| |
3646940 | Mar., 1972 | Timm et al. | 128/419.
|
3650276 | Mar., 1972 | Burghele et al. | 128/419.
|
3667477 | Jun., 1972 | Susset et al. | 128/419.
|
3800800 | Apr., 1974 | Garbe et al. | 128/408.
|
3870051 | Mar., 1975 | Brindley | 128/422.
|
3933147 | Jan., 1976 | Du Vall et al. | 128/788.
|
4102344 | Jul., 1978 | Conway et al. | 128/419.
|
4106511 | Aug., 1978 | Erlandsson | 128/407.
|
4387719 | Jun., 1983 | Plevnik et al. | 128/421.
|
4607639 | May., 1986 | Tanagho et al. | 128/419.
|
4688575 | Aug., 1987 | Du Vall | 128/788.
|
4785813 | Nov., 1988 | Petrofsky | 128/733.
|
4785828 | Oct., 1988 | Maurer | 128/788.
|
5117840 | Jun., 1992 | Brenman et al. | 128/788.
|
5199443 | Apr., 1993 | Maurer et al. | 128/788.
|
Primary Examiner: Hindenburg; Max
Attorney, Agent or Firm: Rogers & Scott
Claims
I claim:
1. A method of improving the pelvic floor muscle strength of a person in a
manner to lessen urinary incontinence comprising;
placing surface electrodes of electromyographic measuring apparatus on the
perineum of the person,
measuring with said apparatus the bladder controlling pelvic floor muscle
strength of the person while the person is tensing the pelvic floor
muscles in a urine stopping manner to obtain an EMG signal, and
adjusting the threshold value of a portable electromyographic measuring
unit to enable the person to repeat said measurement at different times to
attempt to obtain better EMG signals in a urinary incontinence reducing
sense, said portable unit giving an audible and/or visual indication when
an EMG signal above said threshold value is achieved.
2. A method according to claim 1, comprising;
measuring with said apparatus the bladder controlling pelvic floor muscle
strength of the person while the person is at rest and not consciously
tensing the pelvic muscles in a urine stopping manner to obtain a first
EMG signal, while the person is tensing the pelvic floor muscles in a
urine stopping manner for a short period of time to obtain a second EMG
signal, and while the person is tensing the pelvic floor muscles in a
urine stopping manner for a longer period of time to obtain a third EMG
signal.
3. A method according to claim 2 wherein the threshold value of the
portable electromyographic measuring unit is adjusted to a value which is
from about 60 to about 80% of the best measurement while the person is
tensing the pelvic floor muscles in a urine stopping manner.
4. A method according to claim 2 wherein the short period of time is in the
range from about 2 to about 5 seconds.
5. A method according to claim 4 wherein the short period of time is about
2 seconds.
6. A method according to claim 2 wherein the longer period of time is in
the range of from about 10 to about 30 seconds.
7. A method according to claim 6 wherein the longer period of time is about
10 seconds.
8. A method according to claim 2 wherein the short period of time is in the
range of from about 2 to about 5 seconds and the longer period of time is
in the range of from about 10 to about 30 seconds.
9. A method according to claim 8 wherein the short period of time is about
2 seconds and the longer period of time is about 10 seconds.
10. A method according to claim 1 further including; repeatedly applying
neuromuscular stimulation in the form of electrical pulses to the pelvic
floor muscles to cause the muscles to repeatedly contract and relax and
consequently grow and increase in strength to lessen urinary incontinence.
11. A method according to claim 10 wherein stress incontinence is to be
treated and said electrical pulses have a peak current in the range of
from about 10 to about 100 milliamps and a frequency in the range of from
about 40 to about 60 Hz and are applied in pulses lasting from about 5 to
about 10 seconds with an interval between pulses in the range of from
about 5 to about 10 seconds.
12. A method according to claim 11 wherein said electric pulses have a peak
current of about 40 milliamps and a frequency of about 50 Hz and are
applied as pulses lasting for about 5 seconds with an interval between
pulses in the range of from about 5 to about 10 seconds.
13. A method according to claim 10 wherein urge incontinence is to be
treated and the electric pulses have a peak current in the range of from
about 10 to about 100 milliamps and a frequency in the range of from about
10 to about 15 Hz and are applied as pulses lasting from about 5 to about
10 seconds with an interval between pulses in the range of from about 5 to
about 10 seconds.
14. A method according to claim 13 wherein said electric impulses have a
peak current of about 40 milliamps and a frequency of about 13 Hz and are
applied as pulses lasting for about 5 seconds with an interval between
pulses in the range of from about 5 to about 10 seconds.
Description
This invention relates to the treatment of urinary incontinence.
Urinary incontinence is of course a well known medical problem and many
attempts have been made to provide methods of treatment. However, none of
the methods previously proposed have proved to be as successful as
desired.
It is therefore an object of the invention to provide an improved method
for treating urinary incontinence.
According to the invention, a method of improving the pelvic muscle
strength of a person in a manner to lessen urinary incontinence comprises
placing surface electrodes of electromyographic measuring apparatus on the
perineum of the person, measuring with said apparatus the bladder
controlling pelvic floor muscle strength of the person while the person is
tensing the pelvic floor muscles in a urine stopping manner to obtain an
EMG signal, and adjusting the threshold value of a portable
electromyographic measuring unit to enable the person to repeat said
measurement at different times to attempt to obtain better EMG signals in
a urinary incontinence reducing sense, said portable unit giving an
audible and/or visual indication when an EMG signal above said threshold
value is achieved.
When the measurement has been made and the threshold value of the
electromyographic unit has been appropriately adjusted by a professional,
the person can perform specified physical exercises which are designed to
improve pelvic muscle control in a manner to reduce urinary incontinence
and then use the electromyographic unit provided to see if better EMG
signals can be obtained, i.e. to see if the exercises are having a
beneficial effect. In due course the person will again be checked by a
professional and a further measurement made. The professional will then
re-adjust the threshold value of the electromyographic unit to give the
person a further incentive to continue the specified physical exercises.
The bladder controlling pelvic floor muscle strength may be measured while
the person is at rest and not consciously tensing the pelvic muscles in a
urine stopping manner to obtain a first EMG signal, while the person is
tensing the pelvic floor muscles in a urine stopping manner for a short
period of time to obtain a second EMG signal, and while the person is
tensing the pelvic floor muscles in a urine stopping manner for a longer
period of time to obtain a third EMG signal.
The threshold value of the portable electromyographic unit may be adjusted
to a value which is from about 60 to about 80% of the best measurement
while the person is tensing the pelvic floor muscles in a urine stopping
manner.
The electrodes may be simply applied to the surface of the body, without
implantation being necessary. In other words, the electrodes can be
non-invasive. The skin need not be prepared with solvents or broken with
needles.
The short period of time may be in the range of from about 2 to about 5
seconds, for example about 2 seconds. The longer period of time may be in
the range of from about 10 to about 30 seconds, for example about 10
seconds.
The method may further include applying neuromuscular stimulation in the
form of repeated applications of electrical pulses to the pelvic floor
muscles to cause the muscles to repeatedly contract and relax and
consequently grow and increase in strength to lessen urinary incontinence.
When stress incontinence is to be treated, the electrical pulses may have a
peak current in the range of from about 10 to about 100 milliamps and a
frequency in the range of from about 40 to about 60 Hertz and be applied
in pulses lasting from about 5 to about 10 seconds with an interval
between pulses in the range of from about 5 to about 10 seconds.
The electrical pulses may have a peak current of about 40 milliamps and a
frequency of about 50 Hz and be applied as pulses lasting from about 5
seconds with an interval between pulses of from about 5 to about 10
seconds.
When urge incontinence is to be treated, the electrical pulses may have a
peak current in the range from about 10 to pulses may have a peak current
in the range from about 10 to about 100 milliamps and a frequency in the
range of from about 10 to about 15 Hz and be applied as pulses lasting
from about 5 to about 10 seconds with an interval between pulses of from
about 5 to about 10 seconds.
The electrical pulses may have a peak current of about 40 milliamps and a
frequency of about 13 Hz and be applied as pulses lasting for about 5
seconds with an interval between pulses of from about 5 to about 10
seconds.
When treating a person with urinary incontinence in accordance with the
invention, the initial treatment session involves the taking of baseline
electromyographic measurements of the strength of the muscles of the
pelvic floor which control urination. Suitable equipment for this purpose
is for example the Speakeasy MC (.RTM.) equipment which is primarily
intended for use in speach therapy. Two surface electrodes are placed on
the perineum of the person and readings of muscle strength in microvolts
are taken while the person is at rest, while the person is exerting
maximum pelvic muscle contraction in a urine stopping manner for a short
period of time, and while the person is exerting maximum pelvic muscle
contraction in a urine stopping manner for a longer period of time. For
example, the short period of time may be about 2 seconds and the longer
period of time may be about 10 seconds.
The person is then taught appropriate exercises such as those known to a
person skilled in the art or other suitable exercises to strengthen the
appropriate pelvic muscles, with emphasis on the short hold time and the
longer hold time mentioned above. The person is then given a portable
electromyographic feedback unit for his/her personal use so that the
person can practice the exercises at home or elsewhere and seek to improve
on the baseline measurements. Suitable equipment for this purpose is the
Speakeasy TH (.RTM.) equipment which again is primarily intended for use
in speech therapy.
Before giving the unit to the person, the threshold value of the unit is
adjusted by a professional to a value related to the person's baseline
measurements, for example from about 60 to about 80% of the person's best
effort during long hold. The settings for such a unit are typically from
about 1 to about 10 microvolts. Thus, the person receives audio and/or
visual feedback from the unit and is thereby encouraged to increase the
feedback output by producing stronger contractions.
In addition to the biofeedback exercises, the person is put on a voiding,
i.e. bladder emptying, regimen which is regularly adjusted by the
professional, for example on a weekly basis. An appropriately set timer
may be provided for this purpose. Every time the timer alarm sounds, the
person must go to the toilet and try to void.
The person may also be given neuromuscular stimulation in the form of
repeated applications of electrical pulses to the appropriate pelvic floor
muscles to cause them to repeatedly contract and relax. Suitable equipment
for this purpose is the Respond Select equipment manufactured by Medtronic
Nortech and intended for use in rebuilding muscles of the shoulder, knee,
hip and hand following disease, surgery or injury. Such stimulation causes
muscle growth and increased muscle strength.
For stress incontinence, namely incontinence caused by various forms of
physical activity, the pulses may have a frequency in the range of from
about 40 to about 60 Hz, preferably about 50 Hz, and last for about 5
seconds with an off interval of about 10 seconds, increasing to lasting
for about 5 seconds with an off interval of about 5 seconds, the session
lasting from about 15 to about 30 minutes. There may be several such
sessions per day.
It has been found that a frequency of about 50 Hz is preferable for stress
incontinence in that it has been found to be the best frequency to enhance
the pelvic floor musculature and improve urethal closure without rapid
muscle fatigue. In other words, such a frequency automates pelvic floor
muscle exercises. It has been found that muscle contraction occurs at or
above about 40 Hz and that frequencies somewhat above about 50 Hz cause
muscle fatigue. Accordingly therefore, about 50 Hz is the prefered
neuromuscular stimulation frequency for treating stress incontinence.
For urge incontinence, namely incontinence caused by a full or nearly full
bladder, pulse frequency may be from about 10 to about 15 Hz, preferably
about 13 Hz, with the pulses being applied as for stress incontinence.
Urge incontinence is treated with a lower frequency because it has been
found that bladder inhibition occurs with lower frequencies. However, at
frequencies below about 10 Hz, some people experience discomfort or pain.
Accordingly therefore, it has been found that a frequency of from about 13
to about 15 Hz is preferable for treating urge incontinence in that this
produces pain-free, low frequency stimulation which results in bladder
inhibition by reflexive mechanisms.
It should be pointed out that the intensity of the neuromuscular
stimulation is not an exact science but depends on the individual person's
reaction to stimulii. The intensity must be sufficient to cause muscle
contraction. It has been found that an intensity of about 40 milliamps is
usually appropriate for stress incontinence and urge incontinence, but
this may not be true in every case. The intensity may in fact be varied in
the range of from about 10 to about 100 milliamps.
Two specific examples of treatment will now be given. The first example is
of a person with urge incontinence and the second example is of a person
with stress incontinence. In each example, EMG signal readings and other
information are given for an initial session and for the subsequent
second, third, fourth and fifth sessions which occurred at weekly
intervals. It will be noted that the EMG signal readings are taken when
the person is sitting and when the person is standing, and that each
reading is taken twice to avoid errors caused by spurious readings.
COMMENTS ON EXAMPLE 1 (URGE INCONTINENCE)
The dramatic improvement by the fifth session is readily apparent. In some
cases, as in this example, it is necessary also to measure abdominal
muscle activity and to condition the person to lessen such muscle
contraction when contracting the pelvic floor muscles. In this example, no
neuromuscular stimulation was required.
COMMENTS ON EXAMPLE 2 (STRESS INCONTINENCE)
Again, the dramatic improvement by the fifth session is readily apparent.
In this example, it was not necessary to monitor abdominal muscle
activity. However, neuromuscular stimulation was applied.
The advantages of the invention will be readily apparent to a person
skilled in the art from the foregoing description, the scope of the
invention being defined in the appended claims.
______________________________________
EXAMPLE 1 (URGE INCONTINENCE)
EMG SIGNAL (uV)
Sitting Standing
______________________________________
FIRST SESSION
1. Person at rest
Pelvic floor 1.11/1.20 1.3/1.31
Abdomen 2.0/2.11 1.9/2.20
2. Short Hold (2 sec.)
Pelvic floor 2.30/1.9 2.21/2.16
Abdomen 5.7/5.0 6.11/6.01
3. Long Hold (10 sec.)
Pelvic Floor 1.96/1.90 2.01/2.70
Abdomen 4.33/4.71 5.31/5.44
4. Suggested voiding interval
20 mins
5. EMG Home Unit Setting
1.5 uV.
6. Neurostimulation Unit Setting
N/A
7. Number of accidents per day
More than 2
SECOND SESSION
1. Person at rest
Pelvic floor .97/1.09 1.19/1.17
Abdomen 1.35/1.01 2.00/2.10
2. Short Hold (2 sec.)
Pelvic floor 3.96/2.91 3.01/3.20
Abdomen 1.55/1.73 1.96/1.80
3. Long Hold (10 sec.)
Pelvic Floor 3.44/3.10 3.27/3.49
Abdomen 1.40/1.75 1.90/1.91
4. Suggested voiding interval
45 mins
5. EMG Home Unit Setting
2.4 uV.
6. Neurostimulation Unit Setting
N/A
THIRD SESSION
1. Person at rest
Pelvic floor .88/.98 1.12/1.20
Abdomen N/A
2. Short Hold (2 sec.)
Pelvic floor 4.14/4.33 4.56/4.9
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 4.01/4.09 4.0/3.97
Abdomen N/A
4. Suggested voiding interval
60 mins
5. EMG Home Unit Setting
3 uV.
6. Neurostimulation Unit Setting
N/A
7. Number of accidents per day
1
FOURTH SESSION
1. Person at rest
Pelvic floor .80/.87 1.0/.93
Abdomen N/A
2. Short Hold (2 sec.)
Pelvic floor 6.11/5.87 5.9/6.02
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 5.44/5.9 4.9/5.22
Abdomen N/A
4. Suggested voiding interval
90 mins
5. EMG Home Unit Setting
4.1 uV.
6. Neurostimulation Unit Setting
N/A
7. Number of accidents per day
0
FIFTH SESSION
1. Person at rest
Pelvic floor .81/.89 1.02/.95
Abdomen N/A
2. Short Hold (2 sec.)
Pelvic floor 10.04/9.77 10.6/11.01
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 9.87/9.8 9.9/10.12
Abdomen N/A
4. Suggested voiding interval
120 mins
5. EMG Home Unit Setting
N/A
6. Neurostimulation Unit Setting
N/A
7. Number of accidents per day
0
______________________________________
______________________________________
EXAMPLE 2 (STRESS INCONTINENCE)
EMG SIGNAL (uV)
Sitting Standing
______________________________________
FIRST SESSION
1. Person at rest
Pelvic floor .89/1.07 .99/1.21
Abdomen N/A
2. Short Hold (2 sec.)
Pelvic floor 2.11/1.80 2.67/2.57
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 1.88/1.57 2.01/1.98
Abdomen N/A
4. Suggested voiding interval
30 mins
5. EMG Home Unit Setting
1.2 uV.
6. Neurostimulation Unit Setting
40 mA
7. Number of accidents per day
more than 2
SECOND SESSION
1. Person at rest
Pelvic floor .99/.89 1.02/1.11
Abdomen N/A
Short Hold (2 sec.)
Pelvic floor 2.99/3.01 3.54/3.77
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 2.50/2.93 3.60/3.89
Abdomen N/A
4. Suggested voiding interval
45 mins
5. EMG Home Unit Setting
2.25 uV.
6. Neurostimulation Unit Setting
40 mA
7. Number of accidents per day
3
THIRD SESSION
1. Person at rest
Pelvic floor .91/.90 .99/1.04
Abdomen N/A
2. Short Hold (2 sec.)
Pelvic floor 3.03/4.11 4.01/3.90
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 3.27/3.98 4.21/4.01
Abdomen N/A
4. Suggested voiding interval
60 mins
5. EMG Home Unit Setting
3 uV.
6. Neurostimulation Unit Setting
Discontinued
7. Number of accidents per day
1
FOURTH SESSION
1. Person at rest
Pelvic floor .77/1.01 .99/1.11
Abdomen N/A
2. Short Hold (2 sec.)
Pelvic floor 5.11/5.78 6.02/6.11
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 4.97/5.0 5.1/5.5
Abdomen N/A
4. Suggested voiding interval
90 mins
5. EMG Home Unit Setting
4.5 uV.
6. Neurostimulation Unit Setting
N/A
7. Number of accidents per day
0
FIFTH SESSION
1. Person at rest
Pelvic floor 1.02/1.09 1.20/1.11
Abdomen N/A
2. Short Hold (2 sec.)
Pelvic floor 8.71/9.21 10.11/10.60
Abdomen N/A
3. Long Hold (10 sec.)
Pelvic Floor 8.90/9.01 10.02/10.90
Abdomen N/A
4. Suggested voiding interval
110 mins
5. EMG Home Unit Setting
N/A
6. Neurostimulation Unit Setting
7. Number of accidents per day
0
______________________________________
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